ER s06e11 Episode Script

The Domino Heart

E.R. Previously on E.R Hi, I'm Jing-Mei Chen. Dr Chen, as a rule, we don't lie about our patients' medical conditions. I cannot thank you enough, Dr. Knight. I'm not a Dr yet. You are to me. Mr. Rollins, this is Lindsey Cordova. So, how can I help you? I want to bury my sister. Where is she Dean? How are you holding up? In all honesty I'm exhausted. Maybe you should come live with me in Chicago. Chicago. snow in the southern plains and rain in Texas going northeast. You see the trough here. That's allowing cold air in. The moisture mixing with snows in Kansas. But this low that's moving - will pull up some Gulf of- - Dad? Hey, Mark. You' re up early. Might snow later. Fifty percent chance. - It's a little loud. - You ought to have a bedroom door. - No, thanks. - I can build you one. I don't want a door. Can you turn that thing down? Hello? Yeah. I'm sorry. My dad's visiting. Yeah. It won't happen again. - Who's calling at this hour? - You woke my neighbor too. No wonder. The walls in this building are paper-thin. - By the way, we're out of coffee. - So I see. There was only a little left. Barely able to get any myself. I'll just go to work. - This early? - Yeah. This early. I like that weather channel. No sense in watching it in San Diego. "Clear and sunny." "Chance of a cloud. Mostly sunny." - Hey, Chuny. - Welcome back! How are the twins? They're great. This is my first whole day without them. - It seems pretty quiet, though. - Actually, no. - Back to work. - See you. I'm right behind you. Vito Camporsero, 29, acrobat. He slipped off the trapeze. - How far did he fall? - About five feet. His armpit caught on the cable. It's not so bad. - Carol, welcome back. - Thanks. Deep laceration to the left axilla, three-liter blood loss. BP's 60 palp. Okay, ready, steady, lift. Four units of O-neg. - Are you the new nurse? - Good to be back. - I need a pulse ox probe. - A gram of Ancef. No water. Anybody know why? - No. - I just got on. - I'll check it out. Are you all right? - All set, thanks. Pressure is crashing. Carol, prep for a subclavian. - Are you hurt? - It's Vito's blood. Dominic carried him down the ladder. - Pulse is 124. - Carol, the Betadine. Oh, yeah. I got it. - It's okay if you're rusty. - I'm fine. I didn't know the circus was in town. Laceration of the axillary artery. - I'm Dr. Romano. - Hello. Help my brother. Check the crits first. Okay. Absent wrist pulses. Let's have a look. - Easy, easy! - You're hurting him! Give him morphine! - Stop it, please. - Almost done. Hold on. - Step back a little bit! - Get these guys out of here! Okay. Okay. Stop, please. Kovac? What the hell are you doing? Let go of me! Hey, call Security! Get your hands off me! - Put four liters at every sink. - What's up? Water main broke. Could be a while before they fix it. - You're not on. - Valerie Page called me. - The girl you ordered L-VAD for? - They found a transplant match. That is great. - They're stacked in Chairs. - I'm on the code team today. I was paged for a respiratory arrest that was a false alarm. What's up? Your dysentery patient used the toilet. - So? - No water? We can't flush. Oh! Well, sorry. I got another case. Put the "Out of Order" sign up. Call Housekeeping. Amira, can we get portable toilets and maybe some air freshener? - You get many accidents in the circus? - No. Not usually. Peng is afraid she won't be able to perform tonight. No, no. The laceration is not bad. Tell her she'll be fine. Thank you. How did this happen? One of the platforms broke. A piece of wood fell right on top of her. Yes, but if the wood fell from above, how did it hit the bottom of her foot? - Like this. You see? - Wow! I think I'll go see this circus of yours. There's one of them. Get him out of here. My mother's had Parkinson's for 15 years. Has her condition changed? The past couple of days, she's been so weak. I'm worried she had a stroke. - Oh, no. Let us help. - No, I don't mind. I do it every day. Good for my health. Right, Mom? To tell you the truth, I'm a burden. Louise has to lift me onto the toilet and sponge bathe me. Oh, come on, Mom. Stop it. She gets dizzy when she sits up. Could it be her heart? Well, we'll check. - Maybe the Parkinson's is worse? - Well, I don't feel worse. Well, you might not. But I'll examine you, run some tests and find out what's going on. You okay? Oh, yeah. Fine. Okay We got an IV cefotaxime order for Exam Two. - Okay. - It's been in the rack. I just checked the rack. - Lady's got pneumonia. - This man has chest pain. I only do one thing at a time. I'm moving as fast as I can. I know. It's your first day back. I know you've gotta get back into the flow. I don't think any of my patients have suffered. I didn't mean to imply that. Why wasn't I paged for the water crisis? We have a plan. I'm on the committee. There's no crisis. We got portable toilets. We got bottled water. It's under control. Except that the O.R. can't sterilize the instruments. We're closed to trauma. That sounds good. If the patients can't make it out or they don't want to freeze we can use the physical therapy pool. A two-gallon dump gives you a solid flush. Thanks for the information. - Sure. - That's good to know. - Hi! - Hi. I was about to eat when my pager went off. I just about jumped out of my seat. This is news worth missing breakfast for. - I forgot my slippers. - You'll get some with your new heart! - Keeping up, Carol? - Oh, God. - Seen the records on my patient? - File room's bringing them. - Did you fax his EKG to his PMD? - Yes. - He said he'd call. - Maybe he's busy. Here's the problem. Paper jam. Fax it again, will you, Carol? - Anyone seen the x-rays on that ankle? - Don't hold your breath. Radiology can't process the film without water. We might be able to grab something to eat. Sounds like fun. - Yeah? - Have a good time. Michael Mueller. Had a seizure while driving, crashed into a wall. He's post-ictal, tachy at 120. We were going to play hockey and he started to shake. Curt Obarr, passenger. He has a forehead lac. - Has he ever had seizures? - Not that I know of. Okay, everybody, nice and easy. On my count. One, two, three. - Get a C-spine, chest, and head CT. - They can't develop x-rays. - All right. Let's get the fluoroscan. - Sinus tach, 130. BP's 124 over 78. Pupils are equal. Does he have medical problems? He uses an asthma inhaler. - Old bruises. Play rough? - He got hit bad last week. - Did he hit his head? - No. Temp's normal, 98.8. Whoa! Let's roll him! - Add a theophylline level. - What's that? Asthma medication. Take too much, this can happen. Louise? Hey. Everything looks okay. Head CT, EKG and the blood tests are all essentially normal. Then why can't she walk? It's probably the Parkinson's. But her neurologist can adjust her medication as an outpatient. Could we talk outside? Yeah, sure. Of course. - Then you're not going to admit her? - Not when there's no reason to. I love my mother. But I can't take her home and care for her when she can't walk. I'm just too exhausted. - Well, maybe you need a home aide. - I can't afford a home aide. She needs to be in the hospital for a few days - so you can adjust her meds. - We can't admit her for that. I'm asking you, please. I'm just so tired right now. It's been such a difficult few weeks. If she could just stay for a couple of days Well, I wish I could help you. But the hospital doesn't allow that. I'm really sorry. Okay, thanks. These are - "Ridiculous" would be one word. - Yes. - Best the gift shop had to offer. - Thank you. You're welcome. I called your mom. She is on her way here. - And your dad is- - Not around. I know the story. - Hello. - Dr. Weaver. - Valerie, how are you? - The proverbial "couldn't be better." - Good. Lucy, do you have a minute? - Sure. Excuse us. We'll be right back. I've looked over the chart. And Valerie has a fever. - Her temperature is 100.9. - That could just be a cold. She needs immunosuppressive agents so she won't reject the new heart. - Even a cold could be fatal. - What are you saying? Notify the transplant coordinator. We may have to decline the heart. Is there anything we can do? It'll be their decision. But I think that's what will happen. I can't believe this. She was so close. - Want me to tell her? - No. No, I'll tell her. Shooting. Yeah, definitely got a fracture on your hand just below the pinky. You can move it back. It's gonna need a cast. I'm lucky. It could've been worse. - How's Curt? - Oh, he's fine. His forehead's being sutured up. - I'm more concerned about you. - I feel fine. Your seizure was caused by an overdose. - An overdose? - Were you trying to hurt yourself? No. My asthma flares up when I'm stressed. So I took a few extra pills. Stressed at work? At home? I'm a landscaper. January's tough. Work stops, the bills don't. - Why the third degree? - I have to ask about depression. If I wanted to die, I'd find a better way. All fixed up. They figure out what's wrong? Yeah. I took too much asthma medicine. Busted up my hand. We have to find someone to play left wing. - Is he gonna be okay? - Yeah. He should be. - How's the car? - Totaled. Don't worry, you're insured. - Can I use this in here? - Sure. I'll get a rental. - When did you pass gas? - An hour ago. - No fever or vomiting. - I agree with your assessment. Mr. Hoyt, you are full of stool. We will give you an enema. - Excuse me, Doctor- - Not now, we're busy. Come back later. - Peter, who's next? - Splenectomy from last week. - Valerie's here for a heart transplant. - Old news. - I stay informed. - Then you know she has a fever. I didn't know. Call the coordinator? - Not yet. - Peter, call her and tell her we pass. Won't you examine her? - We can't operate if there's a fever. - But her white count is normal. Good effort. But a fever spells infection. It's an infection of her L-VAD. I did research on Medline and found articles from Stanford. The treatment is antibiotics, remove the device, give the new heart. Peter, go work her up. I'll talk to the transplant service. You are like a crazed Energizer Bunny on this. You keep going and going - Thank you. - and going and going - We're out of I and D kits. - I'll check the suture room. I don't need one. Just wanted to let you know. Big trauma came in. I haven't checked all my rooms yet. - I'm not criticizing you. - I'll get to it. It must be strange coming back after being off for six weeks. - Not really. - If you need a break- - Why? - Maybe you need sleep. I'm getting plenty of sleep. - Dr. Malucci, is there a problem? - Yeah, chief. There is. - Check this out. - Dolison? Her husband took them. He's vomiting blood. What is this? They're from Mexico. Combo painkiller and steroid. Unbelievable. Be sure ICU gets him on a steroid taper. - Cleo. - Yeah? When I said I was trying to get out of here early - to go eat- - Wish I could get out early. - So, what if we made it later? - Don't wait on me. Carol? - You all right? - Oh, I'm fine. - You don't look fine. - No, really. I am really fine. First day back must be tough. Why don't you just leave? No. I'm gonna sit here and have a good cry. And then I'll feel better. It's what I do at home. You see? I am- I'm better already. Thanks, Elizabeth. - Carol, are you okay? - Oh, I'm fine. - She's overwhelmed. - I don't blame her. - The diapers, the dishes- - The feedings. Laundry. - Then a 12-hour shift. - How will she do it? Staying focused with the patients. All she wants to think about are her babies. Carol, if there's anything we can do Okay. I'm really confused. You were gonna cancel the transplant. And now I can have the heart? You need a day or two of antibiotics before you can get the transplant. - So I lose the heart after all. - No. You have a very low fever. We think we can clear up the infection with a few doses and still do the transplant. If the antibiotics don't work? - Worst case? - Yeah. Worst case. After surgery you could develop a life-threatening infection. - What would you do? - It's your decision. I know. Would you have the surgery? The risk is small. And you've waited a long time. I would go for it. How long have you been with Curt? - A while. - Everything okay? Yeah. What happens when the two of you fight? What makes you think we fight? Everybody has arguments. You got bruises, stressed out. You OD'd on your medication. I'm trying to put it all together. It's not uncommon for fights to turn physical. People don't mean for it to happen. No, no. I know they don't. Something just sets it off. That ever happen to you? I forgot to get the dry cleaning. He- He hit me. He said he's sorry and promised he'd never do it again. Has he? So there have been other times. I'd like you to talk to a social worker. They have experience with these things. Okay? I don't know. I don't know. Dr. Corday? - Lindsey, how are you? - I'm all right. It was my sister's funeral yesterday. I wanted to thank you. You really don't have to. The police said that he finally told you where he left Jenny. Yes. I'm trying to forget him. I just hear his voice all the time. And it's very gentle. But it's just saying these awful things. Now, you listen to me. That's what he wanted. To make you suffer. You don't let him win. He's nothing. He can't hurt you anymore. I know. I know. It's okay. - How long is the operation? - Four, five hours. - They let med students watch? - If they're on the transplant service. - That means you can't stay? - They'll make an exception. - Thanks. - Yeah. Can you do me a favor? I forgot to feed Spoony. My cat. Tell my mom? Yes. I'm gonna go change. I'll see you. Can I have a moment with him? - I knew you'd come. - Did you? When I woke up and I found you hadn't done what you said you'd do I was glad. The fact that you were a coward never even occurred to me. Your conscience is bothering you. Isn't it? - It is, actually. - Why? Because you nearly killed me? Or because you didn't have the guts to? Because I enjoyed the power I had over you. When I could've let you bleed to death. When your heart stopped. When the morphine took you under. I held your breath in my hands and I wanted to repay the pain you'd caused. But then I looked at your sad little body. And I saw what a pathetic man you are. I realized I didn't want power over you at all. That my job, for better or worse, was simply to put you back together. See, I don't give a damn if you go to the chair or spend your life in prison. My job's done. You were my patient, you were sick, you're better. Goodbye, Mr. Rollins. - You can take him. - Come back! I haven't finished with you yet! Get back here, Corday! Corday! Do you have any chest pain? I'm a little lightheaded. - What happened? - Code blue. She slipped on the ice. - I was helping Mom into the car. - My wheelchair fell. Did you hit your head or lose consciousness? Louise? I don't think so. I fell first. I don't know. - Put her on a monitor. - You want her? - I just discharged her. - I believe in continuity of care. No head trauma, check her hips. - I'm so sorry, Mom. - I'm all right. - Her BP is 170/95. - Is that bad? It's a little high. Get a CBC, chem panel, cardiac enzymes, EKG and postural vitals. I'm fine. - I'm just so tired. - What was she here for? Exacerbation of Parkinson's. She hasn't been able to walk for days. It's harder to take care of her. - Her head CT was normal. - I see. - Atrial cannulation complete. - Umbilical tape? - How long does the L-VAD stay? - Until bypass. Aortic cannula's looking good. Here we go. Kill the air pump. - Clamp the aortic graft, Peter. - Okay. And got it. Open the venous line. - Anyone looking for a heart? - You're early, Shirley. Sorry. Take it up with the FAA. - Is it too early? - No. It can wait on ice for a while. - Wow! That's her new heart. - Yeah. It sure is. - He denied it? - Said he never touched him. - I thought he was ready to talk. - Victims change their minds. - He loves and wants to protect him. - Or he's afraid. Will you be around? - Thinking about asking him again? - Maybe. - Give me a call. - Thanks. Carol, how are you? - Four hours and 43 minutes left. - Counting minutes is bad. Can someone take this ingrown toenail? A real bitch. Carol. - She's exhausted. She needs a break. - I can't. - You can't? Or you won't? - Both. - Just say you're ruling out a stroke. - I can't lie. Sometimes we make a judgment call. We bend the rules a little. I bent them and got in trouble. Then you're in the wrong department. Listen, everybody does soft admits. It's just part of the drill. I know what you're saying. I'm not admitting her. She's my patient. It's my call. - Okay. Okay, you're right. - Yeah? I don't agree with you. But you gotta do whatever you think is best. - Well, thanks for your input. - Anytime. Hey, Amira? I need a telemetry bed for Louise Duffy. - Wait. You're admitting the daughter? - Yeah. I want to rule out an Ml. - You're kidding? - She may have unstable angina. - She slipped on some ice. - It's my patient. It's my call. - Where's the mother supposed to go? - Your patient. Your call. A bunch of us got into a fight at the hockey rink. You're not gonna be safe until you get out of this. I'll wear more pads. Most domestic homicides have a history of physical abuse. - You trying to scare me? - Yes. - You need to get away from him. - I got the rental. We're set. - You okay? - Fine. - Is he ready? - We need a CT scan. - Why? - He had a head trauma. - We play hockey. - I want to clear him medically. - I wanna take him home. - You should stay. - Do you understand the risk? - He understands. - I'm not so sure. - Why don't we-? Mike, shut up. If he needs to sign something, he'll sign it. Right? You don't have to go. It's your decision. Thanks. But I feel better now, really. We should get home. One more dispo and I'm out of here. - What's that? - It's from the vending machine. - And the cafeteria? - No water. Can't cook. Then don't eat. That'll kill you. Anyone seen Chuny? I'm waiting for a translator. - Sorry. - What's the problem? Father-daughter combo present with aplastic anemia. - Both of them? - Yeah. Strange. No toxic exposure. - Let me see. - Bone marrow's not making squat. - They in there? - Yeah. Why? - What are you doing? - I got a hunch. - What? - Hold on. - Son of a bitch! - What? - What are they saying? - They got shots for their colds. - Get the doctor's name? - They went to a pharmacy. A shot from a pharmacy? Back-room clinic. They smuggle drugs up from Mexico. Oh, God! He gave them aplastic anemia. - What are you doing? - They gave me the address. We should call the police. They see a squad car, they'll bolt. - Cleo, we need you. - Go ahead. - They're my patients. I'll handle it. - They're all yours. - What are you gonna do? - Don't worry. Trevor, we're gonna take care of you, sweetheart. - Femur fracture? - Auto versus pedestrian. He was alone. - Call my mom. - We already tried. - Someone call Housekeeping! - Amira, can you call Ortho? Can you walk? I'll pull the car around. - Water's all hooked up. - Oh, finally! - Somebody has to sign this. - Dr. Greene? Sure. Why not? - Water back on? - No. Gotta check the pressure. I'm in the ambulance bay. Can we page a beeper on the code team? If you know the number. Isuprel's down to four mics. - Wow! - What? Someone else's heart is keeping her alive. Kind of cool. Makes you want to be a surgeon? - Vent settings? - Tidal volume: 700. AC: 14. Fl: 02.5. - Shouldn't she be breathing on her own? - Anesthesia lasts longer in some. Dr. Benton, her gaze is deviated to the right. Valerie, squeeze my hand! We're going to CT. Call Radiology. Unhook her. Let's bag her. Let's go! Come on! - Did you page the right number? - I hope so. He's coming! He's coming! Oh, my God! Oh, my God! John, are you all right? - Are you all right? - Yeah. Now, that's a 10. - Looking good there, Carter. - So, no code? No code. You okay? I could've killed myself. - It's payback time. - Payback for what? For blackmailing me. I admitted Mrs. Duffy. - Really? - You're surprised? You think I'm so heartless, I'd ship her to a nursing home? - You were heartless to discharge her. - If I were really heartless I wouldn't tell you that there's toilet paper stuck to your shoe. What was that? Somebody help! What happened? He was putting stuff in the trunk! We should move him! - We need a backboard! - He's got a flail chest! Malik, get an airway kit and Dr. Greene. - And turn this water off! - I thought I had it in first gear. - It went backwards! - He's barely breathing! - My God, I'm sorry! - Don't worry. We got it. - This guy needs chest tubes. - I'll intubate. 80 tube. - Wait out here. - I'm losing the pulse! Okay. Set up the rapid infuser and prep for a thoracotomy. - Decreased breath. - Prep the chest. - He backed into him? - Pinned him to the truck. - Tachy at 128. - Pressure's down to 70. - Give me a 10 blade. - Set up two Thora-Seals and suction. I'm in. Bag him. - 32 French. Let's go. - Curved Kelly. - Pulse ox dropping to 82. - Mine's in. Hook it up. Thora-Seal's not bubbling. - Pressure's at 60. - There's no suction. All right. Try the other one. - Nope. - What's going on? Wall suction's generated by water. No water, no suction. Chuny, go down to Central and get a portable suction. - I'm in. - Pulse ox, 75. We need to re-expand his lungs. - We're waiting on suction. - What about that vacuum cleaner? The guy was using it at Admit. - Lydia? - Got it. We need something like clay to make a seal. - Merocel sponges. - We'll need 20 of them. - Amp of atropine. - Get the crash cart. - Found him. - Bring it down and get me water. Lost his pulse. We're in P.E.A. - Okay, amp of epi. - Start chest compressions. Sats are down to 72. Okay, pour it. Keep going, keep going, keep going. Okay. Okay, here we go. Hold compressions. Yep. - I hear breath sounds. - Pulse ox up to 85. Ninety-two. Good save. - Dr. Romano- - Just a second. Thanks, Peter. It was a stroke. Yes. They tried streptokinase but couldn't open up the vessel. - Can she recover? - Truth? She's in a permanent vegetative state. - The L-VAD gave her a brain clot. - We don't know. This is not your fault. I'm the one who put it in, remember? We make medical decisions. Nothing is risk-free. - I better go talk to her mother. - Yeah. Hold on. UNOS has identified a potential recipient in Milwaukee. - What are you talking about? - A domino heart procedure. We give the new heart to someone else. You need to get family consent. - But she'll- - She's already dead, Miss Knight. - Where's he going? - Four east, ICU. - Thanks. He's gonna be okay? - We'll see. Tell me what happened. He asked me to pop the trunk. I was trying to pull forward. - I thought I had it in first but I- - You went backwards. I'm not used to driving a stick. I thought they'd have to admit me for hypothermia. Do you want to use this? I'm okay. Cool trauma. It's not so bad when doctors work together. Assess the patient, come up with a plan. Are you still angry about the way I handled Louise and Mrs. Duffy? No. - You're mad about the practical joke? - No. I'm disappointed that you couldn't admit you made a mistake. That your way of dealing with it was to devise some silly gag. You're right. Things will be easier if you deal with things honestly. John- Thank you. - Oh, and, no more practical jokes. - That's a good idea. She said yes. Hey, Lucy. I'm sorry. - I got x-rays on that belly pain. - Finally. Water's back for an hour. What takes so long? I don't know. - Oh, my God! - What? My patient ate nails! Chuny, call O.R and get Surgery down right now. What are you doing? - Made it through the day? - Almost. Good to have you back! - You're lucky to be alive. - Malucci. What'd you do? - Nothing, chief. Just a sucker punch- - Broken bones? Short a few brain cells. - Guard with your left next time. - Right. Thanks, chief. I tell him I have a sore throat, he doesn't even look in my mouth. - Dipyrone. - The FDA banned this. He brings out a vial and wants to give me a shot. Chloramphenicol. - You didn't. - No. I grabbed it and ran. - That's when it got violent. - Hope it was worth it. I got evidence. They're going down. Cleo, you got a minute? Sure. Hold that. - So, you gonna be able to get off? - Yeah, looks like it. - Wanna get dinner? - Where you guys going? - It's just us. - What happened to everybody? - That's what I was trying to explain. - Are you asking me out? Yeah. - What do you think? - He's pretty shaken up. - He had a seizure? - Right. You cleared him to drive? He doesn't have epilepsy. Too much asthma medicine. He didn't have any in his system. Okay. Anything else I should know? - No. That's it. - Okay, thanks. - Hey. Everything okay? - Police are satisfied with your story. - I guess you got what you wanted. - How's that? I'll be safe at home tonight. The social worker's around. Why don't we-? No. No, I'm all right now. Dr. Greene, your pops locked himself out of your apartment. Okay, Malik. Thanks, Dr. Greene. I appreciate your encouragement. - Lucy, you look like you're freezing. - What? It started snowing. You look very cold. I am. - No. That's okay. - No, come on. - I'm European. We like to be gallant. - Thanks. So, are you off? I've got two tickets for the circus. No. Actually, I'm just coming on. Then what were you doing here all day? Not enough, as it turns out. It's never been easy for me to be here. Sometimes I felt like I would never fit in. That's something I know about. But then I've moved around a lot. And now I'm used to it. At the beginning of every day, I'm grateful that I'm walking in here and not being carried in on a gurney. And at the end of every day, if I've helped just one person it's been worth it. That didn't happen today. And it makes me sad. Hey, your day is not over. - Maybe this is your one person. - Doubt it. Yes. But let's see if I'm right, huh? - And miss the circus? - I have had enough circus for today. Come on. What have you got? Paul Galinski, snowmobile into a tree. Facial fractures. Couldn't tube him. Too much blood. - He's all yours. - Looks like a difficult one. I'll talk you through it. Ever used a trach light? - No. - Okay. I'll show you how.